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General NPI Number Information
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NPI Number | 1467806596
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Entity Type | Organization
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Legal Business Name | ARCHANGEL HOME CARE INC
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Dates
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Enumeration Date | 04/14/2016
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Last Update Date | 04/14/2016
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Provider Practice Location Address
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Address Line | 2148 45TH STE 205
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City | HIGHLAND
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State | IN
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Zip | 46322
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Country | US
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Telephone | 312-437-1632
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Fax |
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Provider Business Mailing Address
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Address Line | 2148 45TH STE 205
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City | HIGHLAND
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State | IN
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Zip | 46322
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ABYOMI GABRIEL OMOMO
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Credential |
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Telephone | 312-437-1632
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State | IN
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